Face Transplants, Then and Now

Pakistan Domestic Violence

WARNING: Some of the following pictures are of a graphic nature. Viewer discretion is advised.

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Pakistan Domestic Violence

WARNING: Some of the following pictures are of a graphic nature. Viewer discretion is advised.

ABC News

Man Steps Out After Face Transplant

Poland's first face transplant recipient has been discharged from the hospital just 11 weeks after the life-saving surgery. The 33-year-old man, identified only as Grzegorz, received the transplant three weeks after losing his nose, upper jaw and cheeks in a workplace accident.

Tomasz Griessgraber/AP Photo

Man Saved by Face Transplant

Polish doctors say they saved a man's life by performing a face transplant just three weeks after he was severely maimed in a workplace accident.

Cancer Center and Institute of Oncology/AP Photo

Man Saved by Face Transplant

Richard Norris speaks with a psychiatrist during a visit to the University of Maryland Medical Center in Baltimore, June 18, 2013. In the 15 years between a shotgun blast that ravaged the bottom half of Norris' face and the face transplant -considered the most extensive face transplant performed to date - Norris faced cruelty from strangers, fought addiction and contemplated suicide.

Patrick Semansky./AP Photo

Man Saved by Face Transplant

Richard Norris speaks with Dr. Eduardo Rodriguez, who led the surgical team that performed Norris' face transplant, during a visit at the University of Maryland Medical Center in Baltimore, June 18, 2013. Norris is now starting a new life with the hope that his path will send a message of hope to people in similar situations and encourage empathy in others.

Patrick Semansky./AP Photo

Man Saved by Face Transplant

University of Maryland Medical Center doctors E. Albert Reece, Stephen T Bartlett and Eduardo D. Rodriguez explain the most extensive full face transplant completed to date performed on Richard Lee Norris, pictured, during a news conference, March 27,2012, at the University of Maryland Medical Center in Baltimore.

Gail Burton/AP Photo

Face Transplant Patient's Transformation

Richard Lee Norris, 37, said he's no longer a recluse after receiving a full face transplant at the University of Maryland Medical Center seven months ago. "People used to stare at me because of my disfigurement," he said. "Now they can stare at me in amazement and in the transformation I have taken."

University of Maryland Medical Center

Face Transplant Patient's Transformation

Carmen Blandin Tarleton, of Thetford, Vermont, speaks with reporters at Brigham and Women's Hospital in Boston, on May 1, 2013. The 44-year-old mother of two underwent the transplant in February after a 2007 attack in which her estranged husband doused her with industrial strength lye, burning more than 80 percent of her body.

Charles Krupa/AP Photo

Face Transplant Patient's Transformation

Carmen Blandin Tarleton, 44, is seen here after being doused in lye by her estranged husband, she recently received a face transplant .

Courtesy Brigham and Women's Hospital

Face Transplant Patient's Transformation

Carmen Blandin Tarleton, 44, received a face transplant after being doused in lye by her estranged husband.

Courtesy Brigham and Women's Hospital

Dallas Wiens' New Face

At a Monday press conference, Dallas Wiens, 26, discussed his life with a new face one year after receiving the first full face transplant in the United States. Wiens suffered life-threatening burns to his head when a boom lift he was driving drifted into a power line in 2008. In March 2011, doctors at Brigham and Women's hospital in Boston worked for more than 17 hours to give him a new face.

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Dallas Wiens Before and After

Dallas Wiens, before and after, the full-face transplant procedure performed at Brigham and Women?s Hospital in March 2011.

Parkland Health and Hospital System|Lightchaser Photography

Chimp Victim Charla Nash's New Face

Charla Nash after her injuries and after her face transplant.

Brigham and Women?s Hospital|Lightchaser Photography

Chimp Victim Charla Nash's New Face

Charla Nash before her accident.

Courtesy Nash Family

Mitch Hunter Before and After

Mitch Hunter, 30, before and after his full-face transplant.

Courtesy Hunter Family|Lightchaser Photography

Face Transplant

This photo shows Connie Culp prior to September 2004, before she was shot in the face by her husband, Thomas Culp. The shotgun blast left her disfigured, smashing her nose, cheek and jaw. It also led to Culp becoming the country's first-ever face transplant recipient.

Courtesy Cleveland Clinic

Face Transplant

The first step for surgeons was to determine the borders of the area that they would remove from Culp's face to create a space for the facial tissues of a deceased donor. Surgeons decided that the damage from Culp's injury called for the replacement of about 80 percent of her face.

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Face Transplant

Once incisions had been made around the periphery of the operating area, surgeons had access to the muscles, blood vessels, bones and other tissues of Culp's face. But removing the skin was only a preliminary step in the extensive face-transplant procedure.

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Face Transplant

The face transplant was more than skin deep. In past operations, surgeons had crafted a makeshift upper jaw and teeth using bone tissue from other areas of Culp's body -- shown here in purple. To make room for the donor tissues, one of the surgeons' first jobs was to remove this previous work.

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Face Transplant

Once the improvised jaw and teeth had been removed -- as well as some extra cartilage -- Culp was left with a large gap in the middle of her face. Once the surgeons had a blank canvas with which to work, they could begin the delicate procedure to reattach the donor facial tissues to the front of Culp's head.

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Face Transplant

The midface from the deceased donor is seen here. Along with the facial skin, surgeons also had to transfer the muscles, nerves, blood vessels and bones in order to achieve a face that would be both aesthetically acceptable and functional.

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Face Transplant

Once the original face had been removed and the graft was available, it was time for the surgeons to start attaching the donor face. The transfer started at 5:10 a.m., and the surgeons knew it would take an additional two hours and 40 minutes to connect the blood vessels of the donor face to Culp's own blood vessels.

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Face Transplant

Once surgeons meticulously connected blood vessels from Culp to blood vessels in the donor face, circulation to the graft tissues was restored. Doctors say this was the "most critical" time of the surgery that could determine whether Culp's body would accept or reject the new face.

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Face Transplant

Perhaps the most delicate part of the procedure, the attachment of tiny nerves and the smaller blood vessels from the donor tissues to Culp's face was a microsurgical feat. The donor tissues would have quickly died if they had not received a proper supply of blood, and the proper reattachment of nerves was necessary if surgeons hoped to restore a modest degree of muscular function to the new face.

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Face Transplant

As surgeons worked to connected blood vessel to blood vessel, they watched to see whether blood would begin to flow into the new transplant. When Culp's blood reached the new face, there was an immediate possibility the blood could reject the tissue as foreign and attack it instead of accepting the donor face as part of her body and nourishing it.

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Face Transplant

As the surgery reached its completion, doctors saw the new donor face turn pink, signaling that the connections between blood vessels had been successful and that Culp's body was accepting the new tissue.

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Face Transplant

The CT scan on the left shows the front of Culp's skull following her facial injury. The shot that she took to her face shattered her nose, cheekbone and jaw. The CT scan on the right is the same view of Culp's skull following her face transplant operation. Surgeons used the facial bones of a deceased donor to reconstruct nearly all of the middle of Culp's face.

Courtesy Cleveland Clinic

Face Transplant

Culp before and after her surgery. While doctors are still waiting to see how much function Culp will regain as the nerves in the graft continue to regenerate, Culp said that she is already pleased with the results. The surgery has drastically improved her quality of life, doctors said, as she can now eat all solid foods, drink from a cup, and smell and breathe on her own through her nose.

Courtesy Cleveland Clinic

Face Transplant

This computer-retouched image projects what Culp will look like after her full recovery, once the swelling from her surgery has completely subsided. While doctors say Culp will enjoy a much more normal life thanks to the surgery, she must also maintain a daily regimen of powerful immunosuppressant drugs in order to prevent her body's immune system from rejecting the donor face.

Courtesy Cleveland Clinic

Jim Maki Face Transplant

James Maki, 59, the second U.S. patient to receive a face transplant, before the operation. Maki sustained severe burn injuries to his face and right arm in 2005 when he fell onto an electrified rail at a Boston subway platform. Dr. Bohdan Pomahac, at Brigham and Women's Hospital in Boston, said that when he initially saw Maki immediately after the accident, he did not know whether the man would survive.

Courtesy Brigham and Women's Hospital

Jim Maki Face Transplant

After his accident, Maki's injuries were initially repaired by stretching skin from his cheeks to cover the part of his face that had been burned away when he fell on an electrified subway rail. Maki said his appearance after the first round of surgeries was socially problematic, as many were repulsed by his appearance.

Courtesy Brigham and Women's Hospital

Jim Maki Face Transplant

An artist's drawing of Maki's injuries after the accident. The burns Maki sustained destroyed his nose, upper lip, cheeks, his right lower eyelid and the roof of his mouth. Many of the nerves, muscles and bones underneath the skin of his face were also destroyed. The face transplant was performed April 9, 2009, led by Dr. Bohdan Pomahac of Brigham and Women's Hospital in Boston.

Courtesy Brigham and Women's Hospital

Jim Maki Face Transplant

An artist's drawing of Maki's injuries after the accident. Even after Maki had lost much of his face in the accident, surgeons still had to remove damaged tissue around the wound. They also had to perform surgery to close the gap between his mouth and nasal cavity so that he could eat.

Courtesy Brigham and Women's Hospital

Jim Maki Face Transplant

Susan Whitman-Helfgot, left, meets with Maki. Maki's face transplant was made possible by Whitman-Helfgot's decision to donate her husband's face when he died last month.

Courtesy Brigham and Women's Hospital

Jim Maki Face Transplant

Whitman-Helfgot embraces Maki after they met for the first time. During a Thursday press conference, Maki expressed his gratitude to Whitman Helfgot, who allowed her deceased husband's face to be made available to transplant to Maki.

Courtesy Brigham and Women's Hospital

James Maki,second person in the world to undergo a face transplant

Maki is shown here after his procedure. Despite the complexities of medical care following his face transplant procedure, Maki experienced only two minor instances of rejection which doctors successfully treated with steroid medication.
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Face Transplant

French doctors in the medical journal The Lancet describe a major facial transplant for a 29-year-old man with disfiguring tumors. So far, doctors are calling the 2007 surgery that replaced most of the man's face a success. The young man can communicate better and has not rejected the donor's facial tissue.

The Lancet

Face Transplant

Severe facial injuries or damage by tumors often mean a reconstructive surgeon must take into account vital structures in the face. Facial transplants go beyond simple plastic reconstruction to using living donor tissue.

The Lancet

Face Transplant

A Chinese farmer who confronted a bear trying to attack his cows ended up needing extensive reconstructive surgery. Now his doctors are showcasing the progress of his rarely performed facial transplant in the medical journal The Lancet.

The Lancet

Face Transplant

After losing nearly half his face to a bear attack, this patient has made remarkable progress thanks to a new type of reconstructive surgery. The facial transplant included connecting arteries and veins and repairing his nose, lip and sinuses.

The Lancet

Face Transplant

Shortly after his face transplant, this man faced the danger that his body would reject donor tissue and attack it as a disease. His doctors gave him four different drugs to control his immune system and other drugs to combat infections, which were tailored to the bacteria found on swabs of his nose and throat.

The Lancet

Face Transplant

Not only did doctors reconstruct the tissue from one 30-year-old man's face after a bear attack, they also needed to reconstruct facial bones underneath. Two years after his 2006 surgery, the farmer is reportedly doing well.

The Lancet

Transplant

This picture shows French woman Isabelle Dinoire on Nov. 1, 2006, one year after her facial transplant surgery. She is wearing makeup in this photo. Doctors in Amiens, France, performed the transplant on Dinoire after she was mauled by her dog and lost much of the flesh on her lower face.

The New England Journal of Medicine

Transplant

This photo, taken in June 2007, shows Dinoire without makeup 18 months after her surgery. Though the scars from the operation are still visible, surgeons are pleased with the result. More important, doctors say that the danger of Dinoire's body rejecting the transplant is largely over.

The New England Journal of Medicine

Transplant

This photo, taken in June 2001, shows what Dinoire looked like four years before the dog attack that disfigured her face.

The New England Journal of Medicine

About Face: Transplant Patient Up Close

The image here shows the large number of muscles, nerves and blood vessels that surgeons had to take into account when performing Dinoire's partial face transplant. Many doctors have since said that the sheer complexity of the operation, combined with its possibility for complications, makes it an impractical choice for many patients.

Courtesy New England Journal of Medicine

Face Transplant

Dinoire met with a number of doctors in the months before her surgery. Her injury occurred while she was sleeping. Dinoire woke up to find that, while unconscious, her nose and lips had been bitten off by her black Labrador -- which was ultimately euthanized. It was only when she attempted, in vain, to smoke a cigarette that Dinoire realized she was without half a face.

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Face Transplant

She could barely speak or eat. The muscles of her cheeks were no longer anchored to those around her lips. Doctors suggested a partial transplant, and despite the risks, Dinoire immediately agreed.

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Face Transplant

Dinoire waited five months for a matching donor with the right tissue, compatible color and quality of skin. During the waiting time, Dinoire wore a mask to cover the lower half of her face much of the time. In these months, doctors had to make sure Dinoire took part in intensive physical therapy to stem the hardening of her muscle and tissues.